This document discusses Median Arcuate Ligament Syndrome and provides details of a 61-year-old man presenting with epigastric pain and vomiting. It notes that the median arcuate ligament can insert low and compress the celiac artery in some people. For young patients presenting with similar symptoms, CT scans often show focal narrowing of the proximal celiac axis with poststenotic dilatation and collaterals visible on inspiration and expiration. Surgery is typically the treatment. It also briefly discusses Prostaglandin-induced hyperostosis, Caffey disease, and differentials for cortical hyperostosis in infants.

1. Median Arcuate Ligament Syndromedrwalidagmy

2. 61 years old man with epigastric pain and vomiting

7. The median arcuate ligament is a fibrous arch unites the diaphragmatic crura .

8. in some people, the ligament inserts low or celiac art originate high.

9. young patients (20–40 y), F : M CT angiograms: focal narrowing in the proximal celiac axis. inspiration and expiration 2ry signs poststenotic dilatation and collaterals.ttt : surgery.

10. angulations and narrowing of the proximal celiac axis. Sagittal 3D image of a patient with epigastric pain

11. Sagittal (MIP) of a patient with recurrent abdominal pain reveals focal calcified plaque.

12. Prostglandin induced hyperostosisdrwalidagmy

18. Caffey disease(ICH)AD .subperiosteal bone formationbefore 6 months, M:f 1:1General hyperirritability, fever and anorexia, painful, firm soft-tissue swelling.PGETTT infants with cyanotic heart disease cortical hyperostosis that mimics ICH. PGE serum levels elevated Indomethacin.

19. DD - Physiological in infant not more than 4 m. - trauma. - Hypervitaminosis A. - scurvy - prostaglandin E1 and E2 administration , 42% of infants for more than 30 days; this increases to 100% in more than 60 days.8 - infection (including syphilis) - metastatic neuroblastoma.

20. Thank you